Numbers After SRT/ADT

I did see that, and it sounded encouraging. He said some are waiting till .7 to get a scan. What did you think? Is my math correct on doubling time?

No, not really - it took 5 yrs to reach 0.2. In fact, survival rates are no different for either immediate or delayed SRT provided it is done within the guidelines @jeffmarc described.
However, doubling time for PSA as well as PSA velocity are very important, so immediately post surgery, if the PSA is going up quickly treatment should probably be initiated even before it hits 0.2, esp. If cribriform cells were present.
Phil

Yes, today I might want immediate therapy, but I don’t really know if I had cribriform or not (doesn’t ring a bell if memory serves) but surgical path was clean so who knows?
Seminal vesicle involvement to me sounds like the horse left the barn so I would want treatment in that case.

No, I don’t either; it does not have to be a discreet tumor or even small ones - just thousands of cells loosely aggregated in the prostate bed and nodes. That’s why you need multiple lighter doses to the entire area.
Phil

Oh man, what good is this freakin scan anyway?! FIVE mm’s? Very disappointing for something so expensive and so highly touted.

I started with RP- Gl 9 4/5, grade 5, with 1 pin with 10% Crib. He said the greatest danger I have at this point is being over treated. Not over treated yet. I think his point is my provider will rush to treat if I were to bust .2 again. Actually, I would put money on a private practice wanting to ring the register with treatment. My SO at the private practice won't admit there was a positive margin. My RO mentioned it, the genitourinary research hospital specialist mentioned it too. He said come see him if I hit 2 and he will be able to find it and treat it. I think high enough to find it and treat it is the key phrase. What do I know? I am a retired controls technician. I always welcome your thoughts, Jeff.

I think you and your doctor both need to pay attention to what is really going on after a radical prostatectomy. Having you do more at .2 PSA Is the standard of care Not an over treatment. You probably saw the below info, but I want to make sure you do see it because it outlines what can go wrong if you ignore the .2 need for immediate action.

As you can see below if you wait until 2 You will need ADT, With a Gleeson nine and a reoccurrence, you need ADT at almost any level of PSA above .2.

You need to get yourself a second specialist. This wait until your PSA hits 2 after having a radical prostatectomy is not just poor care, it ignores all the guidelines. That is the guideline for what to do if you start off with just radiation.

From Ascopubs about what PSA to do salvage radiation.

≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

At .22 I started ADT and had 25 sessions of salvage radiation. So far everything appears to be as it should with 10 weeks to go on adt. His proposed protocol is if my cancer returns after this salvage procedure.
For my information what are your medical credentials? Please understand, I am not being combative, but you elevated your advice above a Hematology Genitourinary oncologist that is the Dept. Co-Chair at the Massey Cancer Center.

See Chip, this is where I get very confused. My rational brain tells me that if my PSA goes up after the SRT/ADT I just completed, the PSA must be coming from somewhere OUTSIDE the treated area - ie, prostate bed and pelvic nodes….but WHERE??
According to Jeff, recent comments by leaders in the RO field say you might not be able to see a lesion less that 5 mm with PSMA PET scan - do you know how freakin BIG that is??
So what if your PSA hits 2.0 and your PSMA shows nada….wait til 3 or 4? After having G9?? I don’t know, I have no answers but Dr Scholtz seems to think this is the way to go as well, so your RO may be following his lead. But this approach scares me, to be honest. Sounds like the PSA version of Russian Roulette.
If my PSA starts going up after all this treatment I might say screw it, take out another mortgage and spend the $100K on Provenge…it won’t bring the PSA down but it might be better than playing whack a mole for the rest of my life.
I hope neither one of us has to find out!! Best,
Phil

I thought current psma scan ability was 2.7mm. Yeah I know how big that is. At this point I am operating on they got it until I know different. He was clear on waiting until 2 as I specifically questioned him on that if I have another occurrence. My thought is they can find it rather than guessing where it is if I hit 2. I do have a bad margin slide in my bed that 2 out of 3 doctors can see which got radiated this winter. My surgeon can't seem to see it lol. I'm just another bozo on the PC bus trying to live my best life.